From: Care for hospitalized patients with unhealthy alcohol use: a narrative review
Clinical issue | Treatment |
---|---|
Assess risk for nutritional deficiency | • Thiamine supplementation. |
• Possibly folate and multivitamin supplement. | |
Assess hydration status and electrolytes (risk for hypocalcemia and hypomagnesemia with or without hypokalemia and hypophosphatemia) | • IV or oral fluids. |
• Oral or IV electrolyte replacement. | |
Risk for acute alcohol withdrawal | • Close observation with validated instrument or prophylactic benzodiazepine, particularly in those with previous withdrawals or history of severe withdrawal (delirium tremens or seizure). |
• Prophylaxis still requires close observation for over or under-sedation. | |
Active alcohol withdrawal | • Symptom-triggered or scheduled benzodiazepine. |
• Close observation with validated instrument with either symptom-triggered or scheduled dosing. | |
• Alternate medication (e.g., phenobarbital) in rare event that benzodiazepine is unsuccessful at controlling agitation. | |
• Possible beta blocker or clonidine for autonomic manifestations if benzodiazepine alone is insufficient. | |
• Possible haloperidol if benzodiazepine alone is insufficient for delirium. | |
 | • Consider other causes of delirium. |